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  • The Ketogenic Diet and Epilepsy: Does It Really Work?

    Image for ketogenic diet article Some seizures in children have no known cause. If these unprovoked seizures recur it is considered epilepsy. Seizures can be stressful for the child and family. Medication can be a very effective treatment for some, but others may need more help to control their seizures.
    A special diet called the Ketogenic Diet may help manage epilepsy in children, particularly with epilepsy that is resistant to medication. The diet requires significantly lower amount of carbohydrates and high amounts of fat. It can be a difficult diet to maintain but for some children the seizure control may be worth the effort. Most doctors will have a person try the diet for up to 3 months to see if it works. If your child responds well to the diet and remains seizure-free for 2 years, your child may also slowly be transitioned to a more normal diet.

    Getting to Know the Ketogenic Diet

    Background

    Treatment of epilepsy was generally ineffective in the early 1900's. In the 1920s, it was found that fasting could reduce the number of seizures but it was not clear why. Fortunately, anti-seizure medications were developed that helped the majority of people with epilepsy. As a result, dietary treatments lost popularity as a main treatment option for epilepsy.
    The ketogenic diet is a high fat, low carbohydrate diet.. The classic diet is made up of 3 parts fat and 1 part carbohydrate and protein. There are variations of the diet, like one that uses medium chain triglycerides as a primary source of fat. You and your child's doctor and dietitian will make adjustments to your child's diet as needed.

    How it Works

    The diet mimics some effects of fasting on the body. Glucose (sugar) is the easiest source of energy for the body. Most of the glucose comes from carbohydrates that we eat. Once the glucose is burned off, the body uses fat as a source of energy. The use of fat creates a by-product called ketones. For reasons not completely understood, the ketones may reduce or eliminate seizures. Your body will also use body fat for fuel when you fast but fasting is clearly not a long term option.

    Making the Change

    Degree of Difficulty

    Any dietary change is difficult. The range of food in this diet is somewhat limited, some find it easier than others to complete the process. To get the most benefit, it is important to follow the diet as closely as possible.
    The transition to this diet will be monitored by a doctor. Your child will also be tested on a regular basis to look for side effects and maintain body function. If your child is not seeing a benefit your doctor may stop the diet and try alternative treatments.

    Let's Eat!

    What kinds of foods will your child be able to eat? Focus on what can be eaten, rather that what cannot be eaten. Keep in mind that the ketogenic diet is fat-based, so fatty foods rule the menu. You can be as creative as you want as long as you are mindful of what your child can eat. Here is a list of possible menu items:
    • Eggs
    • Meats (bacon, steak, hamburger)
    • Full-fat dairy low in carbohydrates
    • Full-fat condiments (mayonnaise, oil, butter)
    • Vegetables low in carbohydrates
    • Limited servings of fruit

    What to Expect

    There is more to the diet than just the food. The fat-based menu does have side effects that may appear within a few days. The good news is they are short term and should disappear as your child's body adjusts to the diet. Keep an eye on your child's progress and discuss it with your child's doctor.

    Common Side Effects

    • Constipation
    • Irritibility
    • Sleepiness
    • Dehydration (make sure your child has adequate fluid intake)

    Unusual, Rare, or Serious Side Effects

    Heart Disease

    Heart disease as an adult is the biggest potentially harmful side effect of eating a high-fat diet. Cholesterol and triglycerides are fats in the blood. High levels can increase the risk of future heart disease. Although the diet leads to significant elevations of fatty substances in the blood, the diet has not been proven to be unsafe. For many, the benefit of reducing or eliminating seizures outweigh the potential of a possible harm developing later in life.

    RESOURCES

    The Epilepsy Foundation of America http://www.epilepsyfoundation.org/

    Teens Health http://www.teenshealth.org/

    CANADIAN RESOURCES

    The Center for Epilepsy and Seizure Education http://epilepsy.ca/

    Epilepsy Ontario http://www.epilepsyontario.org/

    References

    Epilepsy. Kids Health website. Available at http://kidshealth.org/parent/medical/brain/epilepsy.htmlUpdated November, 2011. Accessed November 7, 2012

    Epilepsy, Frequently Asked Questions. Centers for Disease Control and Prevention website. Available at http://www.cdc.gov/epilepsy/basics/faqs.htm. Updated August 3, 2011. Accessed November 5, 2012

    Ketogenic Diet. Epilepsy Foundation website. Available at http://www.epilepsyfoundation.org/aboutepilepsy/treatment/ketogenicdiet/index.cfmAccessed November 8, 2012

    Ketogenic diet in children. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated August 2, 2012. Accessed November 5, 2012.

    Kwiterovich P, Vining E, Pyzik P, et al. Effect of a high-fat ketogenic diet on plasma levels of lipids, lipoproteins, and apolipoproteins in children. JAMA. 2003;290:912-920.

    Lefevere F, Aronson N. Ketogenic diet for the treatment of refractory epilepsy in children: A systematic review of efficacy. Pediatrics. 2000;105:e46.

    Nephrolithiasis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated November 1, 2012. Accessed November 5, 2012.

    5/14/2008 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Neal EG, Chaffe H, Schwartz RH, et al. The ketogenic diet for the treatment of childhood epilepsy: a randomised controlled trial. Lancet Neurol. 2008 May 2. [Epub ahead of print]

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